Table 2

Net DALYs averted at full and actual implementation levels

 Intervention (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) ICER ranking ICER ($) Pop. DALYs averted per 1000 Cases per annum (1000 s) Actual imp. level Total cost (full imp.;$1000s) Total cost (actual imp.; $1000s) Total DALYs averted (full imp.; 1000s) Total DALYs averted (actual imp.; 1000s) Net DALYs averted (full imp.; 1000s) Net DALYs averted actual imp.; 1000s) Financial value to the healthcare system of moving from actual to full imp. ($1000s) Male circumcision 38 22 45 4073 12% 146 730 17 608 39 634 4756 25 423 3051 1 372 314 Isoniazid preventive therapy for HIV+ no (TB) 4 1 887 55 50% 80 40 1118 559 1098 549 33 673 First-line treatment for new TB cases for adults 5 3 393 14 64% 178 114 1045 669 1002 641 22 122 First-line treatment for new TB cases for children 7 3 393 12 64% 117 75 888 568 851 545 18 789 Clean practices and immediate essential newborn care (home) 9 3 368 671 0% 416 – 237 – 227 – 13 909 Management of pre-eclampsia (magnesium sulfate) 23 6 168 20 80% 45 36 535 428 483 386 5923 Voluntary counselling and testing 41 25 40 8031 15% 36 309 5446 167 25 98 15 5120 Rotavirus vaccine 22 6 177 651 0% 3097 – 88 – 80 – 4920 Households owning at least one ITN/LLIN 33 13 77 6752 56% 13 737 7706 228 128 180 101 4847 Malaria treatment: first trimester—uncomplicated 19 5 198 305 33% 1025 341 109 36 100 33 4087 PMTCT 27 11 94 53 55% 600 332 157 87 130 72 3561 Malaria treatment: uncomplicated—second line (adult, >36 kg) 13 4 260 4372 2% 1186 18 59 1 56 1 3354 Malaria treatment: uncomplicated—second line (adult, <36 kg) 14 4 260 4372 4% 593 21 59 2 56 2 3285 Labour and delivery management 28 11 89 918 65% 1281 833 170 111 139 91 2992 First-line treatment for retreatment TB cases for adults 6 3 393 2 65% 100 65 131 85 125 81 2688 Mass media 2 1 903 16 879 71% 7609 5402 150 107 148 105 2627 Malaria treatment: uncomplicated (adult, <36 kg) 11 4 260 4372 30% 3463 1039 59 18 56 17 2383 Interventions focused on men who have sex with men 48 51 20 34 5% 1256 63 232 12 40 2 2311 Antenatal care (four visits) 36 15 68 918 46% 11 230 5110 90 41 68 31 2289 First-line treatment for retreatment TB cases for children 8 3 393 2 65% 66 43 111 72 106 69 2283 Malaria treatment: second trimester—uncomplicated 20 5 198 305 67% 235 157 109 72 100 67 2047 Antenatal corticosteroids for preterm labour 40 25 40 165 0% 406 – 47 – 28 – 1718 Newborn sepsis— full supportive care 39 24 42 81 40% 417 167 60 24 37 15 1346 Cotrimoxazole for children 1 cost saving 127 13% 220 28 0 0 23 3 1208 Interventions focused on female sex workers 47 51 20 23 30% 655 197 161 48 28 8 1184 Vaginal delivery, skilled attendance 31 12 83 918 65% 5181 3368 67 43 54 35 1153 Malaria treatment: uncomplicated (adult, >36 kg) 12 4 260 4372 70% 4267 2987 59 41 56 39 1021 Tetanus toxoid (pregnant women) 24 7 149 918 84% 115 96 104 87 92 77 905 Malaria treatment: uncomplicated—second line (children, <15 kg) 17 4 260 1042 2% 35 1 14 0 13 0 799 Malaria treatment: uncomplicated—second line (children,>15 kg) 18 4 260 1042 4% 71 2 14 0 13 0 783 Schistosomiasis mass drug administration 42 29 35 389 13% 77 10 24 3 13 2 670 Vitamin A supplementation in pregnant women 25 7 140 124 65% 125 81 33 22 30 19 634 Malaria treatment: uncomplicated (children, >15 kg) 16 4 260 1042 40% 4768 1907 14 6 13 5 487 Antibiotics for pPRoM 45 40 25 64 30% 39 12 30 9 10 3 450 Maternal sepsis case management 44 39 26 64 0% 2731 – 20 – 7 – 449 Management of severe malnutrition (children) 46 50 20 51 80% 2437 1949 199 159 36 29 446 Isoniazid preventive therapy for children in contact with patients with TB 3 1 900 2 85% 7 6 45 38 44 38 408 Malaria treatment: uncomplicated (children, <15 kg) 15 4 260 1042 60% 4576 2746 14 8 13 8 325 Vaginal delivery, with complication 32 12 83 138 51% 804 410 10 5 8 4 242 Measles vaccine 26 9 106 651 99% 528 523 107 106 90 89 55 Management of obstructed labour 30 12 86 92 100% 1100 1100 2497 2497 2026 2026 – Caesarean section 43 32 31 34 100% 672 672 327 327 157 157 – Caesarean section (with complication) 29 12 86 5 100% 172 172 137 137 111 111 – Pregnant women sleeping under an ITN 34 13 77 1469 100% 2990 2990 50 50 39 39 – Under five children who slept under ITN/LLIN 35 13 77 494 100% 1006 1006 17 17 13 13 – Blood safety 37 15 66 40 100% 1626 1626 12 12 9 9 – Malaria treatment: pregnant women— complicated 21 5 198 16 100% 140 140 6 6 5 5 – Case management of MDR TB cases 10 3 297 0 100% 12 12 5 5 5 5 – Malaria treatment: pregnant women—complicated 21 5 198 16 100% 140 140 6 6 5 5 – Caesarean section (with complication) 29 12 86 5 100% 172 172 137 137 111 111 – Management of obstructed labour 30 12 86 92 100% 1100 1100 2497 2497 2026 2026 – Pregnant women sleeping under an ITN 34 13 77 1469 100% 2990 2990 50 50 39 39 – Under five children who slept under ITN/LLIN 35 13 77 494 100% 1006 1006 17 17 13 13 – Blood safety 37 15 66 40 100% 1626 1626 12 12 9 9 – Caesarean section 43 32 31 34 100% 672 672 327 327 157 157 – IPT (pregnant women) 52 110 9 735 100% 35 35 0 0 −0 −0 – GIT cancer 63 804 1 0 50% 3 1 0 0 −0 −0 −0 Cervical cancer (first line) 65 1087 1 2 50% 162 81 0 0 −0 −0 −0 Ischaemic heart disease 61 453 2 128 15% 4 1 0 0 −0 −0 −2 Diabetes, type I 57 296 3 23 15% 4304 646 0 0 −0 −0 −5 High cholesterol 49 68 15 223 1% 6703 67 1 0 −0 −0 −6 Basic psychosocial support, advice and follow-up, plus antiepileptic medication 50 82 12 506 3% 1266 38 1 0 −0 −0 −14 Treatment of depression 56 265 4 169 1% 332 3 0 0 −0 −0 −23 Diabetes, Type II 58 296 3 138 15% 4211 632 0 0 −1 −0 −30 Treatment of acute psychotic disorders 66 1646 1 169 1% 958 10 0 0 −1 −0 −42 Treatment of bipolar disorder 62 557 2 523 3% 10 362 321 0 0 −1 −0 −87 Treatment of schizophrenia 67 1646 1 2363 14% 13 413 1878 0 0 −10 −1 −512 Hypertension 55 159 6 846 10% 1338 134 44 4 −71 −7 −3912 ORS 54 153 7 8662 69% 937 647 147 102 −221 −152 −4197 Zinc (diarrhoea treatment) 51 99 10 7455 0% 1788 – 244 – −150 – −9207 Condoms 53 127 8 8031 47% 22 883 10 755 482 226 −517 −243 −16 813 ART for men 59 312 3 332 75% 21 159 15 961 1005 758 −4104 −3,096 −61 848 ART for women 60 312 3 509 82% 32 440 26 669 1541 1267 −6292 −5,173 −68 665 Paediatric ART 64 892 1 107 25% 7657 1892 1556 384 −21 074 −5,206 −973 334
• ART, antiretroviral therapy; DALY, disability adjusted life year; GIT, gastrointestinal; ICER, incremental cost effectiveness ratio; IPT, intermittent preventive therapy; ITN, insecticide-treated bed net; LLIN, long-lasting insecticidal net; MDR, multidrug resistant; ORS, oral rehydration salts; PMTCT, prevention of mother to child transmission; pPRoM, preterm premature rupture of membranes; TB, tuberculosis.